6 Questions (and Answers!) About Diabetic Eye Disease

November is American Diabetes Month. With more than 38 million Americans – 15% of our country’s adult population – experiencing diabetes, it’s an important time to bring awareness to this serious condition and its many consequences.

For example, diabetes affects your eyes and can cause your vision to deteriorate. Diabetic Eye Disease is not just a singular disease – it encompasses several diseases of the eye, including diabetic retinopathy (which is the leading cause of blindness in middle-aged Americans), diabetic macular edema, glaucoma, and cataracts. These eye diseases are directly connected to poor blood sugar control over a long period of time.

How does diabetes impact the eye?

High blood sugar causes damage to the tiny blood vessels in the retina, and this damage leads to a cascade of conditions that affect your vision. Poorly controlled diabetes increases your risk – the higher your A1C reading, the higher your risk of developing Diabetic Eye Disease.

• Diabetic Retinopathy begins as bleeding into the retina. As the disease progresses to its most advanced stage, abnormal blood vessels grow on the surface of the retina. Retinal scarring and permanent loss of cell function marks the end-stage of this condition. About one in three people with diabetes who are over the age of 40 have some signs of diabetic retinopathy. Diagnosing and treating Diabetic Retinopathy in its early stages can reduce the risk of blindness by 95%!
• As the disease worsens, some blood vessels close off, which can cause an abnormal growth of vessels that may bulge, weaken, and cause fluid to leak into the retina. This leads to dangerously high pressure inside the eye and also swelling (called edema) of the macula and the tissue surrounding the macula – a condition known as Diabetic Macular Edema. This edema can cause retinal detachment and vision distortion — and even vision loss as the disease progresses.
• Cataracts cause the eye’s lens to cloud and are fairly common in older adults. People with diabetes are two to five times more likely to not only develop cataracts but to develop them at an earlier age than the general population.
• Glaucoma risk doubles in individuals with diabetes. The disease affects the optic nerve, which carries electrical impulses to the brain. This silent thief of sight can cause you to lose your vision so slowly that you don’t notice it, until one day – you notice decreased vision. But unfortunately, it’s too late – vision loss from glaucoma is not reversible. It’s gone forever. Early detection and treatment can help save your vision!

What are the symptoms of Diabetic Eye Disease?

Often, there are no symptoms at the beginning or even in the middle stages of diabetic eye disease, which highlights the importance of an annual comprehensive eye exam with your optometrist and the importance of managing blood sugar levels. As Diabetic Eye Disease advances, decreased vision is the primary complaint.

Additional symptoms include:

• Difficult distance vision
• Difficulty reading or with “up close” work
• Difficulty driving – particularly at night
• Floaters – dark strings or spots in your visual field
• Blurry or wavy vision
• Vision that changes frequently – sometimes day-to-day
• Dark areas in your visual field
• Poor color vision
• Flashes of light

How is Diabetic Eye Disease diagnosed?

During your annual comprehensive eye exam, your optometrist will use a variety of testing methods to check the overall health of your eyes – including the retina.

• Visual acuity – this is the eye chart that measures your ability to see at various distances.
• Tonometry – the “puff” of air that your optometrist or their technician directs onto your eye to measure the intraocular pressure inside the eye.
• Pupil dilation – to enable your optometrist to see the retina and optic nerve clearly. A dilated eye exam can help to identify and treat eye problems early – before vision loss occurs.

How often should diabetic patients see their optometrist?

Simply put: Often and very regularly. Follow your optometrist’s guidance on how often you should have an eye exam. Keep in mind that early diagnosis and treatment of Diabetic Eye Disease is the key to slowing its progress and, as much as possible, maintaining your good vision.

In general, people with diabetes should have a yearly comprehensive eye exam at a minimum, and some people who have been diagnosed with diabetic retinopathy or diabetic macular edema may need exams as often as every 2 to 4 months.

What are the treatments for Diabetic Eye Disease?

Treatments vary depending on how severe your case is. If a patient is diagnosed and the stage of the disease has been determined, your optometrist will decide the course of treatment. With macular edema, the treatment may include laser treatments or steroid injections to reduce swelling. If the disease has progressed to the advanced stage, a same-day surgical procedure may be the best course of treatment.

If you develop cataracts, the cloudy lens can be removed surgically and replaced with an artificial lens. You may need a new prescription for eyeglasses after removal of cataracts.

How can Diabetic Eye Disease progression be slowed?

• The ABCs of diabetes management: A1C — manage your blood glucose, blood pressure, and cholesterol
• Stop smoking!! Need help? Quit Assist or SmokeFree.gov or Heart.org can help.
• Have a dilated eye exam once a year
• Eat healthfully
• Exercise regularly
• Take your medications as prescribed

The sooner you manage your diabetes symptoms and blood sugar levels, the better. Even if you have struggled in the past, you may be able to slow the progression of Diabetic Eye Disease by making better choices now.

Be proactive; as your optometry office, we are here to help. Call today and make an appointment for your annual exam: Protecting your eye health is worth the effort!